Splenic rupture from Baseball Sport accident: a case study

A case of Splenic rupture from Baseball Sport accident has been reported by Naoya Kobayashi which has been published in BMC Surgery.

According to history, a 41-year-old male was hit by a pitch (HBP) in the left abdomen during his first at-bat baseball game.He was standing close to the batter's box and the pitcher who attempted to throw an inside pitch. The ball struck the patient and fell to the ground. He continued, but when swinging at his second at-bat (he hit a ground ball), he experienced abdominal discomfort and had to leave the game.

He was taken to a nearby hospital, where abdominal computed tomography (CT) revealed a splenic injury. He was pale but alert after being transferred to the emergency and critical care center, and he was receiving intravenous fluids. The vital signs were stable, but the systolic blood pressure was low (80 mmHg). The injured area was bruised, but there was no underlying rib fracture. Contrast-enhanced CT revealed traumatic splenic injury and intra-abdominal hemorrhage. Following that, an emergency laparotomy was performed. During the operation, hemorrhagic ascites was observed, and approximately 2300 mL of blood was aspirated. Abdominal exploration revealed a 4-cm tear in the inferior extremity's splenic capsule (medial spleen) and active hemorrhage near the splenic hilum. Further investigation revealed vascular injury to the hilum as well as a deeply extending parenchymal injury.

Because of the severity of the injury and hemorrhage, doctors decided to perform a splenectomy. Prior to removing the spleen, the vessels at the splenic hilum were ligated and hemostasis was achieved. 1120 mL of red blood cells and 1200 mL of fresh-frozen plasma were transfused during the procedure. Histopathologic examination of the spleen revealed parenchymal hemorrhage and partial capsule rupture. The intraoperative and histologic findings led to the diagnosis of splenic rupture. The patient's recovery was uneventful, and he was discharged home six days after surgery.

Previously, traumatic splenic injuries were primarily treated surgically; however, as endovascular therapy has advanced, transcatheter arterial embolization (TAE) has recently contributed to the survival of patients in an increasing number of cases. If a patient develops shock or uncontrollable hemorrhage after TAE, the treatment strategy should be changed immediately to laparotomy.

Although extremely rare, batters who are hit in the abdomen by a pitched baseball should be evaluated for the possibility of intra-abdominal organ injury. In the absence of an overlying rib fracture, extracorporeal shock wave-induced injuries such as splenic rupture can occur.

Reference:

Kobayashi, N., Kano, H., Kuwana, T. et al. Be careful of splenic rupture caused by hit by a pitch during a baseball game: a case report. BMC Surg 21, 382 (2021). https://doi.org/10.1186/s12893-021-01376-z